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A radical cancer therapy – Don’t treat

158401-chemotherapyThe following Op-Ed by Nora Zamichow appeared in the LA Times Oct 24, 2014.

We learned about my husband’s inoperable brain tumor from a nurse who doled out the news as though providing his cholesterol count.

Mark stood frozen. I clutched at him and wailed.

“Are you OK?” the nurse asked.

Was she insane? Which part of this could remotely be described as OK?

Mark worried about how we would tell the kids, three adult children from his first marriage and our 11-year-old daughter.

“We will tell them,” he said thoughtfully, “that we hit a rough patch.” Only Mark could refer to a widespread brain tumor as a “rough patch.”

My husband was a hardcore journalist, relentless in pursuit of a good story, no matter whose sacred cow he skewered. He was also a really smart guy, winning a scholarship to Harvard University from a San Bernardino public school. He began studying chess at age 15 and eventually became a ranked master. After leaving newspapers, he ran his own public relations firm. His greatest fear, he later told me, was that something might happen to his brain.

After diagnosis, we hit the ground running, signing on with a top doctor at UCLA. Quality of life, we told him, was our most important priority. But when he offered hope that Mark might be able to gain another five years of life, we leapt at the chance.

Still reeling from the diagnosis, we readily agreed to the arduous treatment course the specialist suggested: six weeks of chemotherapy and radiation conducted concurrently. This would be followed by five days of chemo every month. At 58, Mark was relatively young and strong, and a doctor told us that 50% of the UCLA patients with his kind of tumor were alive after five years.

We never thought about that other 50%, and when we discussed treatment options, no one proposed the most basic: Do nothing.

But amid the flurry of medical meetings, a friend introduced Mark to a doctor who had also been diagnosed with a brain tumor, though one considered less aggressive. Mark spoke with him. Oddly enough, this fellow had passed up certain treatments. Why, we wondered, would he do that?

Why? Because doctors don’t die like the rest of us.

Physicians often decline treatment in cases of terminal illness, wrote Dr. Ken Murray in “How Doctors Die,” an essay for the Zocalo Public Square website.

“What’s unusual about [doctors],” Murray wrote, “is not how much treatment they get compared to most Americans, but how little.”

Physicians are much more likely than the general public to sign a living will, specifying what, if any, treatments they want in the event of serious illness, according to a 2003 study.

In a recent Stanford University School of Medicine study of 1,081 doctors, 88% said they would choose a do-not-resuscitate order for themselves. Further, this group agreed they did not want treatment if they had an “incurable and irreversible condition that will result in … death.”

Doctors are more familiar not just with death but with the foibles of trying to flout it.

“Of course, doctors don’t want to die,” wrote Murray. “But they know enough about modern medicine to know its limits.”

In the case of the physician who spoke to my husband, he declined treatments when he found conflicting opinions about their efficacy. “I am not anti-therapy,” he said. “I am for evidence-based therapy.”

What about the rest of us? We depend on doctors to level with us. But do they?

“The overall quality of communication between clinicians and patients with advanced illness is poor, particularly with respect to discussing prognosis,” according to a recently released Institute of Medicine report.

Still, hard truths sometimes come out. As Mark climbed atop the table for his first radiation dose, he turned to the radiologist and asked how long he was likely to live. Without blinking, the radiologist replied: “At best, a year and a half.”

By the end of six weeks of chemotherapy and radiation, Mark could no longer walk. Without warning, he would get dizzy and fall to the floor, a phenomenon doctors could not explain. Despite our repeated entreaties about preserving Mark’s quality of life, the doctors advised staying the course.

That meant a series of terrifying episodes. One afternoon, Mark walked into a public restroom and locked the door. As I waited for him, I heard a crash and realized I could not enter the bathroom.

Days after another fall, Mark ended up in the hospital. Under the influence of anti-seizure medication, he had begun to hallucinate. Strange fish dived at him from the ceiling. I had to put myself between him and a hospital nurse he thought was trying to harm him.

After the next round of chemo, Mark again landed in the hospital, where his condition worsened rapidly. He was bedbound and, often, unresponsive. It was hard to know if he knew me. Within weeks, even the doctors recommended hospice.

“It is possible,” the oncologist said, “that treatment made Mark’s tumor grow rather than shrink.”

Mark defied all odds and predictions, regaining strength and lucidity while in hospice care. He began walking again. His oldest son played piano for Mark, and they enjoyed late night movies on a bedside TV. Mark watched Stephen Colbert with our young daughter cuddled next to him. He went fishing with the kids and shot guns at a range with friends.

I read aloud to Mark, poetry and short stories. And finally, one day I read him Murray’s essay. Mark listened carefully, and then he comforted me. “If I had the slightest chance of living longer with treatment, then of course we would have to try.”

But I also realized my husband had no memory of the various stages of his illness. He could not recollect all the falls, hallucinations and hospitalizations.

If I were granted a do-over, would I subject him to treatment, knowing it might turn out as it did? No.

But oncologists, as a doctor friend put it, are peddlers of hope, and non-treatment was never presented as an option.

Only at the end, after we opted out, did it feel like Mark grappled with the cancer on his own terms.

Ten months after his diagnosis, my husband died with me by his side in bed at home.

Nora Zamichow is a Los Angeles journalist and former Times staff writer.
Twitter: @Zamichow

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CLEAN YOUR KIDNEYS

Years pass by and our kidneys are filtering the blood by removing salt, poison and any unwanted substances entering our body. With time, the salt accumulates and this needs to undergo cleaning treatments. How are we going to overcome this?

It is very easy, first take a bunch of parsley or cilantro (coriander leaves) and wash it clean.

Then cut it in small pieces and put it in a pot and pour clean water and boil for ten minutes, let it cool down and then filter it and pour in a clean bottle and keep it inside the refrigerator to cool.

Drink one glass daily and you will notice all salt and other accumulated poison coming out of your kidneys by urination. Also, you will be able to notice a difference that you never felt before.

Parsley (cilantro) is known as a great cleaning treatment for kidneys and it is natural!

How to Prevent Yourself from a Fall, Trip, or Slip

Increased Risk of Fall Accident Begins at Age 40
By: Junji Takano

One of the main health concerns of elderly people is falling, which is often related to poor balance. In fact, many studies show that people begin to have balance problems starting at the age of 40 years.

The older you get, the weaker your physical body and sensory abilities will be, which are all factors in having poor balance.

Falling Accidents

In Japan, more than 7,000 people a year die from falling accidents, which already exceeds the number of traffic accidents.

In this article, we’ll examine in more details the cause of falling and why you lose balance as you age.

## Test Your Balance by Standing on One Leg
You can determine how good your balance is by measuring the length of time that you can stand on one leg.

How to Stand on One Leg

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The following table shows the average balance time by age group in a study conducted at a Japanese health institute.

Average time with eyes open
20-39 years old: 110 seconds
40-49: 64 seconds
50-59: 36 seconds
60-69: 25 seconds

Average time with eyes closed
20-39 years old: 12 seconds
40-49: 7 seconds
50-59: 5 seconds
60-69: less than 3 seconds

If your balance time is below average, then you’ll have higher risk of falls, or slipping and tripping accidents.

In the above study, women tend to lose their balance more than men but only by a small margin (1-2%).

From this study, it is also evident that there’s a sudden significant decrease in the ability to maintain balance among middle-aged people (40 years and above).

Please take note that the numbers stated above are only average. There are people who were able to maintain balance much longer, and there are also those who were only able to maintain their balance at much shorter time regardless of age and gender. The reason why they vary is explained further below.

## The Soles of Your Feet Have Sensors
The skins all throughout your body have significant amount of tiny pressure sensors or mechanoreceptors. Some areas have few pressure sensors, while other areas have thousands, like on the soles of your feet.

Pressure Sensors or Mechanoreceptors on the soles of the feet

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The pressure sensors on the foot soles provide information to your brain to help balance your body.

As you get older, the sensors will get weaker and your foot sole lose sensitivity.

But there are also other factors that can lead to weaker pressure sensors.

## Poor Blood Circulation Can Disrupt the Pressure Sensors
In our study, people are almost twice as likely to be in a fall accident caused by poor blood circulation.

This can be simulated by soaking your feet into ice cold water for about 3 minutes.
Because of the cold temperature, the pressure sensors on the foot sole begin to lose sensitivity.

# Pay Attention to Your Forward-Moving Foot
If your forward-moving foot hit something, your body will be off-balance causing you to fall or trip.
Well, it’s a matter of common sense to always have your eyes on path and watch where you are going.

Remember the old adages – “Prevention is better than cure”,
“An ounce of prevention is worth a pound of cure”,
“Look before you leap” etc.

But that’s not the only problem.

Here are the other two major reasons why you stumble while walking.

1. Your forward-moving foot is pointed down.
If your foot is pointed down while making a step, then you are more prone to falling.
To avoid this, your forefoot or toes should be flexed upwards as shown on the image below.

Flex Your Toes Upward while Walking

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2. You walk like a pendulum.
The height of your step can greatly increase your risk of falling.

To prevent this, your forward-moving foot must be higher off the ground (at least 5 cm) while the knee is raised high as shown on the image below.

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Proper Height of Foot When Making a Step

Actually, all the mechanoreceptors located throughout your body as well as the soles of your feet are sending information to the brain that include muscle contractions and joint angles. 

When this information is not transmitted well to your brain, which happens as you get older, then the movement will get weak or ineffective making it hard for you to maintain your foot higher off the ground.

## How to Prevent Yourself from a Fall, Trip, or Slip

1. Keep Your House Clean
There are a lot of things in your house that can contribute to clutters that can cause you to trip or fall.
Always make sure to put away or store properly all personal belongings and other unnecessary things even if it is only a newspaper, remote control, and laundries scattered on the floor or carpet.

2. Stretch Your Feet and Ankles

Feet Exercise

Toe Exercise

You might think that your feet do not need exercise or stretching compared to other parts of your body, but in reality, feet stretching exercise can really help your feet maintain balance.

3. Keep Your House Warm and Ensure Adequate Lighting
Cold muscles and pressure sensors work less well and are less responsive to signals.

A decreased temperature will also cause your muscles to have less strength and less flexible, which can lead to accidents.

Always try to keep your house warm or wear proper clothes and footwear, especially during winter or cold weather.

Since most falls occur indoors, make sure your house has adequate lighting.

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About the author:
Junji Takano is a Japanese health researcher involved in investigating the cause of many dreadful diseases. In 1968, he invented PYRO-ENERGEN, the first electrostatic therapy device for electromedicine that effectively eradicates viral diseases, cancer, and diabetes

Turmeric is Good

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Go Bananas!

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Researchers challenge double mastectomy
Survival rates akin to other procedures
September 2, 2014 

By Mackenzie Carpenter / Pittsburgh Post-Gazette
More and more women are choosing to aggressively treat a cancer diagnosis in one breast with a double mastectomy, but new research says that won’t make a difference in long-term survival rates.

A large new study by the Stanford University School of Medicine and the Cancer Prevention Institute of California found that the rate of double mastectomies jumped from 2.0 percent in 1998 to 12.3 percent in 2013. But survival rates were similar to those who had the more targeted procedure of breast-conserving surgery — when just the malignant lump is removed, followed by radiation. The findings were published Tuesday in the Journal of the American Medical Association.

“When faced with a new breast cancer diagnosis, many patients assume that they will achieve a survival advantage by pursuing the most aggressive surgical strategy,” wrote Lisa Newman, director of the Breast Care Center at the University of Michigan, in an editorial accompanying the JAMA article.

That assumption is misguided, based on results of the study, which analyzed survival for nearly 200,000 patients in the California Cancer Registry from 1998 to 2011. In that group — women with cancer in one breast — 55 percent had just the lump removed followed by radiation treatment, 39 percent had one breast removed and 6 percent had both breasts removed. The 10-year survival rate was 83.2 percent, 81.2 percent, and 79.9 percent, respectively. The difference among the three was not statistically significant.

The analysis doesn’t break down different types of breast cancers, but it is the first to directly compare survival rates following the three most common breast cancer surgeries.

These findings might prompt insurers to think twice about covering double mastectomies after cancer is found in one breast, and it’s important to consider whether such surgery is justified “in an era of escalating medical costs and uncertainty regarding how to contain these costs while continuing to promote a healthy population,” Dr. Newman wrote.

A mastectomy is a major procedure that can require significant recovery time and may entail breast reconstruction, the lead author, Allison Kurian, an assistant professor of medicine and of health research and policy at Stanford, said in a statement. “Whereas a lumpectomy is much less invasive with a shorter recovery period,” she said.

Nonetheless, younger women in particular are opting for a more drastic approach. In 2011 alone, 33 percent of women with cancer in one breast under age 40 opted to remove both breasts, compared to 3.6 percent in 1998. Most of those choosing double mastectomies are white, have private insurance and receive treatment at a National Cancer Institute-designated cancer center, the researchers found.

Local breast cancer experts weren’t surprised by the findings.

“This confirms what medical professionals have always suspected,” said Kathleen Erb, a breast cancer surgeon at Allegheny General Hospital. “It tells us what we felt was true: There is no survival benefit to removing an unaffected breast, except in special cases.”

Those special cases would include women who test positive for the so-called BRCA1 or BRCA2 genes or other mutations. A genetic predisposition may mean that a double mastectomy can lower risk significantly, even if cancer hasn’t been diagnosed yet, noted Kandace McGuire, a surgeon who is director of the pre-menopausal breast cancer program at Magee-Womens Hospital of UPMC.

In May 2013, Hollywood star Angelina Jolie made headlines when she decided to have a preventive double mastectomy after testing positive for the BRCA gene. Other celebrities have had the surgery as well.

”There’s this attitude, ‘I never want this to happen again.’ I can’t tell you how many times I’ve heard women say that to me” when requesting a double mastectomy, said Dr. McGuire, even though the likelihood of the initial cancer recurring in either breast is quite small.

”Most women diagnosed with breast cancer live a long, long life, and removing the opposite breast doesn’t improve that already good outcome.”

 

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